(Updated National immunization Schedule 2018, IAP Timetable 2021)

1. VACCINES
&
IMMUNIZATION
(Updated National immunization Schedule 2018, IAP Timetable
2021)
Dr Priyanka Amonkar, MD (Pediatrics)
Senior Resident, Department of Pediatrics
MGM Medical College, Navi Mumbai

4. BCG
Type Live attenuated
Composition Danish 1331 strain of M. bovis.
Freeze dried form (lyophilized). Stored in dark colored ampoules (light sensitive)
Reconstituted with Normal saline. No antibiotics or preservatives(Can cause TSS).
Indication for immunization Given to all children at birth to prevent TBM & Miliary TB
Dosage 0.1 ml
Schedule Single dose from birth to within 1st month of life
Catch up: till 1 year of age under UIP, till 5 years of age as per IAP guidelines
Mode of administration Intradermal at left deltoid just above its insertion into humerus. Wheal of 5-7mm
using tuberculin syringe.
Prior cleaning with only saline
Adverse reactions Local: swelling, tenderness, abscess, non healing ulcer, secondary bacterial
infection, keloid
Regional: Left axillary lymphadenopathy
Systemic: fever, erythema nodosum, mediastinal lymphadenitis, osteomyelitis,
disseminated TB
Contra-indications Immunodeficiency, immunosuppressant drugs, allergy to vaccine components
Storage 2-8o C. After reconstitution, use within 4 hrs
Additional note Post immunization changes:
-Wheal disappears within few minutes
-Papule develops by 2-4 weeks
-Increases in size to 5-8mm by 6 weeks
-Develops into an ulcer which heals by 8-12 weeks

5. Oral Polio Vaccine(OPV) Inactivated Polio Vaccine (IPV)
Type Live attenuated Killed (grown in tissue culture and inactivated in formalin)
Composition Sabin vaccine. Bivalent Contains Type 1 and 3 poliovirus. No
preservative. Neomycin present.
Salk vaccine. Trivalent type 1,2 & 3 poliovirus
Indication for immunization All infants and children. Included in UIP All infants and children. Included in UIP
Dosage 2 drops 0.5ml (IM)
Fractional dose: 0.1ml (ID)
Schedule At birth dose of OPV is must. Given in place of IPV when it is not
feasible. Extra doses to be given on all supplementary immunization
activities (Pulse polio immunization)
Catch up: till 5 years of age
6,10,14 weeks IM as combination vaccine or two fractional
doses ID at 6& 14 wks. Booster at 16-18 months and 4-6
years
Catch up: till 5 years of age. Two doses at an interval of 8
weeks. Followed by booster 6 months later
Mode of administration Oral IM anterolateral aspect of thigh in infants & young children
and deltoid in older children or fractional dose ID
Adverse reactions Vaccine associated paralytic poliomyelitis (VAPP)
Vaccine derived polio viruses (VDPV)
Local pain, redness, swelling, fever, allergic reactions
Contra-indications Immunodeficiency, fever, diarrhea Allergy, fever
Storage Extremely thermo-labile. - 20 o C at manufacturer/distributer level (up
to 2 yrs). 6 months at 2-8o C. 1-3 days at room temperature. Has Vaccine
Vial Monitor
2-8o C
Additional note Efficacy of vaccine after single dose is low. Hence multiple doses
required. Provides mucosal immunity (IgA antibodies) & herd immunity.

6. Hepatitis B Hib Vaccine
Type Recombinant vaccine All vaccines are conjugated
Composition Surface antigen of Hep B produced by recombinant technology in yeast cells &
adsorbed onto aluminum hydroxide
PRP-T: Type b capsular polysaccharide conjugated with
carrier protein tetanus toxoid
HBOC: carrier protein diphtheria toxoid
Indication for immunization All children, adults at high risk such as health care workers, recipients of
frequent blood transfusions, uses of IV drugs, household contacts
All children below 5 years of age, unimmunized children
above 5 years of age having functional or anatomic
asplenia (sickle cell, splenectomy), immunodeficient (HIV,
malignancy, congenital)
Dosage 0.5 ml less than 18 yrs and 1 ml in more than 18 yrs 0.5ml
Schedule Any one of the following: 0 -1 mon-6 mon/ 6-10-14 wk (along with DPT)/ total
4 doses permissible 0-6-10-14 wks.
Catch up: : 0-1 mon-6 mon
Routine: 6,10,14 weeks as pentavalent(UIP). 6,10,14
weeks & booster at 12-18 months (IAP)
Catch up under IAP schedule: up to 5 years
6-12 mon: 2 primary doses 8 weeks apart & booster at 12-
18 months
12-15 mon: one primary dose & booster after 8 weeks
> 15 mon: single dose
Mode of administration IM anterolateral aspect of thigh in infants & young children and deltoid in older
children
IM anterolateral aspect of thigh
Adverse reactions Local pain, fever, allergic reaction, vey rare myalgia, diarrhea, abdo pain, GBS Pain, redness, swelling
Rare: fever, rashes, urticaria, vomiting, diarrhea
Contra-indications Known hypersensitivity, severe febrile illness Known hypersensitivity, severe febrile illness
Storage 2-8o C. Should not be frozen 2-8o C. Should not be frozen

7. DwPT DaPT Tdap dT TT
Type Whole cell DPT vaccine Acellular Pertusis Vaccine Standard dose tetanus & reduced dose
diptheria & acellular pertusis
Standard dose tetanus &
reduced dose diptheria
Tetanus Toxoid
Composition Diptheria toxoid: 25Lf
Tetanus toxoid:5Lf
Killed whole cell B.Pertusis baccili: 20000-30000 million
Adsorbed Aluminum Phosphate
Thiomersal as preservative
Instead of using whole cell, certain key
components of pertussis important for
inducing immunity are used i.e
Pertusis toxin(PT), Filamentous
hemagglutinin(FHA), Pertactin (PRN)&
Fimbrial hemaggliutinins (FIM).
Treated with formalin to obtain toxoids &
adsorbed onto aluminium salts
Diptheria toxoid: 2 Lf
Tetanus Toxoid: 5 Lf
Pertusis antigens reduced dose: PT, FHA,
PRN,FIM
Diptheria toxoid: 2 Lf
Tetanus Toxoid: 5 Lf
5 Lf of tetanus toxoid
Indication for immunization According to UIP & IAP all children 6weeks to 5 years Current recommendation is to use either DTaP
or DTwP.
DTaP especially to those who developed rare
systemic side effects with DTwP
Due to shift of pertussis infection in older
population over time, pertussis vaccination with
reduced dose has been considered in
adolescents & adults
-Routine immunization at 10 & 16
yrs & pregnancy. Now replaced by
Tdap & td
-During injury
Dosage 0.5 ml 0.5 ml 0.5 ml 0.5 ml 0.5 ml
Schedule Routine: 3 doses at 6-10-14 wks(as pentavalent in UIP),
booster at 16-18 months & 5-6 yrs
Catch up: :
Less than 7 years: 0,1 & 6 months. 2nd booster can be
skipped if last dose given beyond 4 yrs.
More than 7 years: Not recommended
Same as DTwP Children who received primary immunization + two DPT boosters: Tdap at 10-12 yrs
& then Td 10 yearly.
Catch up vaccination above 7 years: Tdap followed by Td at 1 & 6 months
Pregnant women: Tdap as early in pregnancy as possible & then Td 4 weeks later
(second dose atleast 2 weeks before delivery). Subsequent deliveries within 3 years:
only single Tdap
During injury
In fully immunized children:
-Minor clean wounds:
1 dose if child immunized > 10 yrs
ago
-Major/unclean wounds: 1 dose if
child immunized >5 yrs ago.
Unknown/unimmunized: 3 doses
Mode of administration IM anterolateral aspect of thigh in infants & young children
and deltoid in older children
IM IM IM IM
Adverse reactions Local pain, tenderness, fever, vomiting, irritability are
extremely common & occur due to pertussis component.
Rare:
-Hyperpyrexia
-Hyporeactive Hypotonic Episode (HHE)
-Persistent crying
-Seizures
-Encephalopathy
-Anaphylaxis
Pain,swelling,tenderness much less
comapered to DTwP. Systemic reactions rare.
Pain, swelling, erythema much less than DTP.
Fever, bodyache
Pain, swelling, erythema much
less than DTP. Fever, bodyache
Local pain, redness, swelling
Contra-indications Beyond 7 years because of increased incidence of severe
systemic reactions beyond this age. h/o anaphylaxis or
development of encephalopathy within 7 days of prior
vaccination.
Beyond 7 years because of increased
incidence of severe systemic reactions beyond
this age.
- - -
Storage 2-8o C. Should not be frozen 2-8o C. Should not be frozen 2-8o C. Should not be frozen 2-8o C. Should not be frozen 2-8o C. Should not be frozen

8. Pneumococcal Polysaccharide Vaccine (PPSV) Pneumococcal Conjugate Vaccine
Type Pneumococcal Polysaccharide Protein conjugate
Composition (Pneumovax)
Contains purified capsular polysaccharides of 23 strains of S. pneumoniae
10 valent (Synflorix)
13 valent (Prevenar)
Polysaccharide capsule of different serotypes of S pneumoniae are conjugated to
carried protein to make them immunogenic in infants, confer long lasting
protection and induce immunogenic memory
Indication for immunization High risk grp: Functional or anatomic asplenia, Nephrotic syndrome,
Immunocompromised pt such as those with HIV, Chronic cardiac/pulmon/renal
disease
PCV 10 & 13 are being introduced in EPI in phased manner.
Offered to all affordable children under 5 yrs of age
Dosage 0.5ml 0.5ml
Schedule Not recommended below 2 years of age.
One dose of PPSV 8 weeks after completing all doses of PCV in high risk grp
UIP schedule: 2 primary doses 6 &14 wks of age and booster at 9 months of age.
Catch up under UIP: If child less than 1 yr of age , all 3 doses to be separated by
atleast 2 months. Above 1 yr of age, only if child has received one dose before 1 yr
of age
IAP schedule:
2-6month old child: 6,10,14 wks & booster in second yr of life
7-11 month old child: 2 primary doses 4 wks apart & booster inn second yr of life
12-23 month old child: 2 doses 8 wks apart
Children 2-5 yr old: single dose
Mode of administration IM IM
Adverse reactions Local pain, redness, swelling, fever, infrequent: allergic reactions Local pain, redness, swelling, fever
Contra-indications Known hypersensitivity, severe febrile illness, pregnancy Known hypersensitivity, severe febrile illness
Storage 2-8o C. 2-8o C.
Additional note Poorly immunogenic below 2 years of age

9. Hepatitis A Vaccines Typhoid Vaccines Rotaviral Vaccines
Biovac Havarix
Vi Capsular Polysacharide
vaccine
(Bio typh)
Vi Conjugate Vaccine
(typbar) Rotavac Rotarix
Type Live attenuated Inactivated Subunit vaccine Subunit vaccine Live attenuated Live attenuated
Composition H2 attenuated strain of Hep A. Lyophilized
form
HM 175 Hep A virus strain
propagated in human diploid
cells, aluminum hydroxide
adjuvant . Formalin inactivated
Purified & inactivated Vi capsular
polysaccharide of S. Typhi with
phenol as preservative
Conjugated to tetanus toxoid Indian Neonatal Rotavirus live
Vaccine 116E
(monovalent, bovine-human
reassortant strain,vero cell
derived)
Human Monovalent Live Vaccine
RV1
Lyophilized powder form
Indication for
immunization
Healthy children above 1 year of age. Not recommended for use in UIP. Offered
to affordable patients.
Special emphasis on: Chronic liver disease, Carrier of Hep B & C, travelers to
endemic region, household contacts of Hep A pt, food handlers
Not recommended for use in UIP.
Offered to affordable patients
Not recommended for use in UIP.
Offered to affordable patients
Given under UIP to all infants less
than 1 year of age
Not recommended for use in UIP.
Offered to affordable patients
Dosage 0.5 ml 0.5 ml 0.5 ml 0.5 ml 5 drops (0.5 ml) 1 ml
Schedule Single dose 12-24 months of age
Catch up: pre vaccination screening
recommended in children > 10 years
2 doses. Minimum age for 1st dose
1 year & 2nd dose 6-18 months
from 1st dose.
Catch up: pre vaccination
screening recommended in
children > 10 years
Single dose in children aged 2
years and above & revaccination
every 3 years
Single dose in children above 6
months of age upto 45 years in
adults
3 doses 6,10,14 weeks
Catch up: Max age for first dose is
1 year under UIP
Only 2 doses at 6,10 wks
Catch up: Max age for first dose is
14 wks 6 days and max age for
final dose is 8 months
Mode of administration SC IM IM IM oral oral
Adverse reactions Local pain, swelling. fever , headache,
malaise. Hypersensitivity
Local pain, swelling. fever ,
headache, malaise.
Hypersensitivity
Local pain, swelling. Fever ,
headache, malaise.
Hypersensitivity
Local pain , swelling, Fever ,
headache, malaise.
Hypersensitivity
Mild. Diarrhea, vomiting, fever
Contra-indications Known hypersensitivity, severe febrile
illness, pregnancy, Immunospressed pt
Known hypersensitivity, severe
febrile illness, pregnancy,
Hypersensitivity, pregnancy Hypersensitivity, pregnancy -h/o anaphylaxis
-h/o intussuseption
-SCID
Storage 2-8o C. 2-8o C. 2-8o C 2-8o C 2-8o C for 6 months
-20o C till expiry
Use within 4 hrs of opening the
vial
2-8o C. Should not be frozen
Additional note VVM

10. MMR Varicella Influenza vaccine Japanese Encephalitis Vaccine
Type Live attenuated Live attenuated Inactivated Live attenuated/ Inactivated
Composition Measles: Edmonston Zagreb Mumps:
Leningrad Zagreb strain
Rubella: RA 27/3 strain
Freeze dried vaccine, to be diluted with sterile
water
OKA strain obtained by propagation
of the virus in human diploid cell
culture. Lyophilized form
Split viron
Quadrivalent
-Live attenuated SA 14-14-12
-Inactivated (jeev) Vero cell culture
derived
Cell culture derived
Indication for immunization Not included in UIP. May be offered to any
affordable child
Healthy children above 1 year, close
contacts of pts with chickenpox
without history of disease/vaccination
in the past, immunocompromised
children
Not included in UIP
Children 6 mon-5 years, High risk
children > 5 yrs eg chronic
cardiac/pulmonary/renal disease, lab
workers & healthcare personnel
Not included in UIP
Individuals living in endemic areas &
travellers to JE endemic areas
(included in UIP)
Dosage 0.5 ml 0.5 ml 0.5 ml 0.5ml
Schedule Routine: 1st dose 12-15 months, 2nd dose 5-6
yrs of age
Catch up: 2 doses 6-8 weeks apart
Routine: 1st dose 12-15 months, 2nd
dose 3-6 months after 1st dose
Catch up: 2 doses 6-8 weeks apart
6 months to 8 yrs: 2 doses 4 weeks
apart & yearly booster
>8yrs: 1 dose yearly
Live attenuated: 1st dose at 9 months
followed by booster at 16-18 months
Inactivated: 2 doses 4 weeks apart for
children aged > 1 year
Upto 15 years of age
Mode of administration SC SC IM Live attenuated: SC
Inactivated: IM
Adverse reactions Local pain, fever, headache, urticaria,
anaphylaxis, measles like rash, arthralgia,
arthritis, aseptic meningitis, orchitis, mild
parotitis
Fever, pain, mild papulovesicular
eruptions in 5%
Pain, swelling, redness, fever,
bodyache, rare: GBS, neuralgia,
thrombocytopenia, anaphylaxis
Local pain, swelling, redness, malaise
Contra-indications Pregnancy, h/o allergy, severe febrile illness,
severe immune deficiency
Pregnancy, anaphylactic reaction to
component, depressed cellular
immunity
h/o allergy to components, h/o GBS,
ongoing acute severe illness
Pregnancy, hypersensitivity
Live vaccine: immunosuppression
Storage 2-8o C. Protect from light. Diluent should not
be frozen
2-8o C. Protect from light. Diluent
should not be frozen
2-8o C 2-8o C
Additional note UIP: MR vaccine introduced in place of measles
vaccine

11. Rabies Vaccine Human anti-tetanus
immunoglobulin
Type Three types:
1) Neural tissue vaccine: poorly immunogenic, severe neurological
reactions
2) Purified duck embryo vaccine: allergic reactions
3) Tissue culture vaccine: extremely safe and require fewer doses. Two
generations
- Human diploid cell vaccine (HDCV)
- Purified chick embryo culture vaccine(PCECV) & Purified vero cell rabies
vaccine (PVRV)
Immunoglobulin
Composition Rabipur: PCEVC. available in lyophilized form
Inactivating agent: BPL
Human IgG specific to tetanus toxin
Indication for immunization Pre-exposure immunization in veterinarians, animal handlers, lab technicians
involved in vaccine production
Post exposure in dog,cat,bats,foxes, racoons, skunks in Category II and III
wounds
Vaccination status unknown/<3 doses, immunodeficient
patients with any type of wound
Dosage 1 ml IM for both pre & post exposure
0.1 ml ID for pre-exposure
250-500 IU
Schedule Pre-exposure immunization: 0,7,28 days
Post exposure :
Essen schedule: 0,3,7,14,28 days
Zagreb Schedule: 2 doses on day 0, 1 dose on day 7 & 21
Single dose
Mode of administration IM anterolateral aspect of thigh in infants & young children and deltoid in
older children (never in gluteal region)
IM
Adverse reactions Local pain, swelling & redness. Fever, malaise, allergic reactions Allergic reactions
Contra-indications Since rabies is universally fatal disease there are no absolute
contraindications to its use
Hypersensitivity to components
Storage 2-8o C. Within 6 hrs of reconstitution

14. THANK YOU